173 results on '"direct cortical stimulation"'
Search Results
152. Incidence and linguistic quality of speech errors: a comparison of preoperative transcranial magnetic stimulation and intraoperative direct cortex stimulation.
- Author
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Bährend I, Muench MR, Schneider H, Moshourab R, Dreyer FR, Vajkoczy P, Picht T, and Faust K
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- Adult, Aged, Brain Neoplasms surgery, Female, Humans, Intraoperative Period, Likelihood Functions, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Reproducibility of Results, Sensitivity and Specificity, Speech Disorders prevention & control, Speech Intelligibility, Wakefulness, Brain Mapping methods, Brain Neoplasms complications, Cerebral Cortex physiopathology, Decompressive Craniectomy adverse effects, Electric Stimulation methods, Neuronavigation methods, Preoperative Care methods, Speech physiology, Speech Disorders etiology, Transcranial Magnetic Stimulation methods
- Abstract
Objective: Given the interindividual variance of functional language anatomy, risk prediction based merely on anatomical data is insufficient in language area-related brain tumor surgery, suggesting the need for direct cortical and subcortical mapping during awake surgery. Reliable, noninvasive preoperative methods of language localization hold the potential for reducing the necessity for awake procedures and may improve patient counseling and surgical planning. Repetitive navigated transcranial magnetic stimulation (rnTMS) is an evolving tool for localizing language-eloquent areas. The aim of this study was to investigate the reliability of rnTMS in locating cortical language sites., Methods: Twenty-five patients with brain tumors in speech-related areas were prospectively evaluated with preoperative rnTMS (5 Hz, train of five, average 105% resting motor threshold) and navigated direct cortical stimulation (DCS; bipolar, 50 Hz, 6-8 mA, 200-μsec pulse width) during awake surgeries employing a picture-naming task. Positive and negative stimulation spots within the craniotomy were documented in the same MRI data set. TMS and DCS language-positive areas were compared with regard to their spatial overlap, their allocation in a cortical parcellation system, and their linguistic qualities., Results: There were over twofold more positive language spots within the exposed area on rnTMS than on DCS. The comparison of positive rnTMS and DCS (ground truth) overlaps revealed low sensitivity (35%) and low positive predictive value (16%) but high specificity (90%) and high negative predictive value (96%). Within the overlaps, there was no correlation in error quality. On DCS, 73% of language-positive spots were located in the pars opercularis and pars triangularis of the frontal operculum and 24% within the supramarginal gyrus and dorsal portion of the superior temporal gyrus, while on rnTMS language positivity was distributed more evenly over a large number of gyri., Conclusions: The current protocol for rnTMS for language mapping identified language-negative sites with good dependability but was unable to reliably detect language-positive spots. Further refinements of the technique will be needed to establish rnTMS language mapping as a useful clinical tool.
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- 2020
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153. Relationship between direct cortical stimulation and induced high-frequency activity for language mapping during SEEG recording.
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Cuisenier P, Testud B, Minotti L, El Bouzaïdi Tiali S, Martineau L, Job AS, Trébuchon A, Deman P, Bhattacharjee M, Hoffmann D, Lachaux JP, Baciu M, Kahane P, and Perrone-Bertolotti M
- Subjects
- Adolescent, Adult, Cerebral Cortex anatomy & histology, Drug Resistant Epilepsy surgery, Electrocorticography, Electrodes, Implanted, Female, Humans, Male, Middle Aged, Nerve Net anatomy & histology, Nerve Net physiology, Predictive Value of Tests, Sensitivity and Specificity, Treatment Outcome, Young Adult, Brain Mapping methods, Cerebral Cortex physiology, Electroencephalography methods, Language, Transcranial Direct Current Stimulation methods
- Abstract
Objective: The authors assessed the clinical relevance of preoperative task-induced high-frequency activity (HFA) for language mapping in patients with refractory epilepsy during stereoelectroencephalography recording. Although HFA evaluation was described as a putative biomarker of cognition, its clinical relevance for mapping language networks was assessed predominantly by studies using electrocorticography (ECOG)., Methods: Forty-two patients with epilepsy who underwent intracranial electrode implantation during both task-induced HFA and direct cortical stimulation (DCS) language mapping were evaluated. The spatial and functional relevance of each method in terms of specificity and sensitivity were evaluated., Results: The results showed that the two methods were able to map classic language regions, and a large and bilateral language network was obtained with induced HFA. At a regional level, differences were observed between methods for parietal and temporal lobes: HFA recruited a larger number of cortical parietal sites, while DCS involved more cortical temporal sites. Importantly, the results showed that HFA predicts language interference induced by DCS with high specificity (92.4%; negative predictive value 95.9%) and very low sensitivity (8.9%; positive predictive value 4.8%)., Conclusions: DCS language mapping appears to be more appropriate for an extensive temporal mapping than induced HFA mapping. Furthermore, induced HFA should be used as a complement to DCS to preselect the number of stimulated sites during DCS, by omitting those reported as HFA-. This may be a considerable advantage because it allows a reduction in the duration of the stimulation procedure. Several parameters to be used for each method are discussed and the results are interpreted in relation to previous results reported in ECOG studies.
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- 2020
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154. A Novel Sequence: ZOOMit-Blood Oxygen Level-Dependent for Motor-Cortex Localization.
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Fang S, Bai HX, Fan X, Li S, Zhang Z, Jiang T, and Wang Y
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- Adult, Brain Mapping methods, Brain Neoplasms surgery, Craniotomy methods, Female, Glioma surgery, Humans, Male, Middle Aged, Motor Cortex physiology, Prospective Studies, Brain Neoplasms blood, Brain Neoplasms diagnostic imaging, Glioma blood, Glioma diagnostic imaging, Magnetic Resonance Imaging methods, Motor Cortex diagnostic imaging, Oxygen blood
- Abstract
Background: Use of conventional blood oxygen level-dependent functional magnetic resonance imaging (conventional-BOLD-fMRI) presents challenges in accurately identifying the hand-motor cortex when a glioma involves the ipsilateral hand-knob. Zoomed imaging technique with parallel transmission (ZOOMit)-BOLD is a novel sequence allowing high spatial resolution with a relatively small field of view that may solve this problem., Objective: To compare the accuracy of ZOOMit-BOLD and conventional-BOLD in hand-motor cortex identification., Methods: A total of 20 patients with gliomas involving the sensorimotor cortex were recruited to identify the hand-motor cortex by both ZOOMit-BOLD and conventional-BOLD. Based on whether the entire or partial glioma directly invaded (was located within) the hand-knob or indirectly affected it by proximity, patients were placed into the involved or uninvolved groups, respectively. Direct cortical stimulation was applied intraoperatively to verify the location of the hand-motor cortex. Overlap indices were used to evaluate the accuracy of the hand-motor cortex identification. An overlap index equal to 0, indicating lack of overlap, was classified as inaccurate classification., Results: The accuracy of motor-cortex identification with ZOOMit-BOLD was 100% compared to only 65% with conventional-BOLD. The average overlap index yielded by ZOOMit-BOLD was higher than that of conventional-BOLD, regardless of whether gliomas directly invaded the hand-knob (P = .008) or not (P = .004). The overlap index in the involved group was significantly lower than that in the uninvolved group with both ZOOMit-BOLD (P = .002) and conventional-BOLD (P < .001)., Conclusion: ZOOMit-BOLD may potentially replace conventional-BOLD to identify the hand-motor cortex, particularly in cases in which gliomas directly invade the hand-knob., (Copyright © 2019 by the Congress of Neurological Surgeons.)
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- 2020
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155. Effects of navigated TMS on object and action naming
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Jyrki P. Mäkelä, Pantelis Lioumis, Henri Lehtinen, Julio C. Hernandez-Pavon, Niko Mäkelä, Aalto-yliopisto, Aalto University, BioMag Laboratory, Clinicum, Department of Diagnostics and Therapeutics, Lastenneurologian yksikkö, and Children's Hospital
- Subjects
CORTEX ,action naming ,genetic structures ,Speech recognition ,medicine.medical_treatment ,speech mapping ,education ,BRAIN-TUMOR SURGERY ,Stimulus (physiology) ,DIRECT CORTICAL STIMULATION ,ERRORS ,Lateralization of brain function ,lcsh:RC321-571 ,Behavioral Neuroscience ,transcranial magnetic stimulation ,medicine ,Offline analysis ,Original Research Article ,SPEECH ARREST ,lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry ,Biological Psychiatry ,object naming ,Postcentral gyrus ,Healthy subjects ,3112 Neurosciences ,LOCALIZATION ,Object naming ,Transcranial magnetic stimulation ,Psychiatry and Mental health ,LANGUAGE AREAS ,Neuropsychology and Physiological Psychology ,Neurology ,FMRI ,Speech disorder ,3111 Biomedicine ,medicine.symptom ,Psychology ,MOTOR ,left hemisphere ,Neuroscience - Abstract
Transcranial magnetic stimulation (TMS) has been used to induce speech disturbances and to affect speech performance during different naming tasks. Lately, repetitive navigated TMS (nTMS) has been used for non-invasive mapping of cortical speech-related areas. Different naming tasks may give different information that can be useful for presurgical evaluation. We studied the sensitivity of object and action naming tasks to nTMS and compared the distributions of cortical sites where nTMS produced naming errors. Eight healthy subjects named pictures of objects and actions during repetitive nTMS delivered to semi-random left-hemispheric sites. Subject-validated image stacks were obtained in the baseline naming of all pictures before nTMS. Thereafter, nTMS pulse trains were delivered while the subjects were naming the images of objects or actions. The sessions were video-recorded for offline analysis. Naming during nTMS was compared with the baseline performance. The nTMS-induced naming errors were categorized by error type and location. nTMS produced no-response errors, phonological paraphasias, and semantic paraphasias. In seven out of eight subjects, nTMS produced more errors during object than action naming. Both intrasubject and intersubject analysis showed that object naming was significantly more sensitive to nTMS. When the number of errors was compared according to a given area, nTMS to postcentral gyrus induced more errors during object than action naming. Object naming is apparently more easily disrupted by TMS than action naming. Different stimulus types can be useful for locating different aspects of speech functions. This provides new possibilities in both basic and clinical research of cortical speech representations.
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- 2014
156. Language mapping with navigated repetitive TMS: proof of technique and validation
- Author
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Phiroz E. Tarapore, Danielle Mizuiri, Srikantan S. Nagarajan, Anne M. Findlay, John F. Houde, Susanne M. Honma, and Mitchel S. Berger
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Adult ,Male ,Cognitive Neuroscience ,medicine.medical_treatment ,Direct cortical stimulation ,Language mapping ,Medical and Health Sciences ,Article ,Speech Disorders ,Lesion ,Young Adult ,Computer-Assisted ,Clinical Research ,Neural Pathways ,medicine ,Humans ,Speech ,Speech arrest ,Language ,Aged ,Cerebral Cortex ,Brain Mapping ,Modality (human–computer interaction) ,Neurology & Neurosurgery ,medicine.diagnostic_test ,Brain Neoplasms ,Psychology and Cognitive Sciences ,Magnetoencephalography ,Signal Processing, Computer-Assisted ,Middle Aged ,Magnetic Resonance Imaging ,Transcranial Magnetic Stimulation ,Transcranial magnetic stimulation ,Neurology ,Signal Processing ,Female ,medicine.symptom ,Psychology ,Neuroscience - Abstract
ObjectiveLesion-based mapping of speech pathways has been possible only during invasive neurosurgical procedures using direct cortical stimulation (DCS). However, navigated transcranial magnetic stimulation (nTMS) may allow for lesion-based interrogation of language pathways noninvasively. Although not lesion-based, magnetoencephalographic imaging (MEGI) is another noninvasive modality for language mapping. In this study, we compare the accuracy of nTMS and MEGI with DCS.MethodsSubjects with lesions around cortical language areas underwent preoperative nTMS and MEGI for language mapping. nTMS maps were generated using a repetitive TMS protocol to deliver trains of stimulations during a picture naming task. MEGI activation maps were derived from adaptive spatial filtering of beta-band power decreases prior to overt speech during picture naming and verb generation tasks. The subjects subsequently underwent awake language mapping via intraoperative DCS. The language maps obtained from each of the 3 modalities were recorded and compared.ResultsnTMS and MEGI were performed on 12 subjects. nTMS yielded 21 positive language disruption sites (11 speech arrest, 5 anomia, and 5 other) while DCS yielded 10 positive sites (2 speech arrest, 5 anomia, and 3 other). MEGI isolated 32 sites of peak activation with language tasks. Positive language sites were most commonly found in the pars opercularis for all three modalities. In 9 instances the positive DCS site corresponded to a positive nTMS site, while in 1 instance it did not. In 4 instances, a positive nTMS site corresponded to a negative DCS site, while 169 instances of negative nTMS and DCS were recorded. The sensitivity of nTMS was therefore 90%, specificity was 98%, the positive predictive value was 69% and the negative predictive value was 99% as compared with intraoperative DCS. MEGI language sites for verb generation and object naming correlated with nTMS sites in 5 subjects, and with DCS sites in 2 subjects.ConclusionMaps of language function generated with nTMS correlate well with those generated by DCS. Negative nTMS mapping also correlates with negative DCS mapping. In our study, MEGI lacks the same level of correlation with intraoperative mapping; nevertheless it provides useful adjunct information in some cases. nTMS may offer a lesion-based method for noninvasively interrogating language pathways and be valuable in managing patients with peri-eloquent lesions.
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- 2013
157. Effects of navigated TMS on object and action naming
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University of Helsinki, BioMag Laboratory, University of Helsinki, Lastenneurologian yksikkö, Hernandez-Pavon, Julio C., Makela, Niko, Lehtinen, Henri, Lioumis, Pantelis, Makela, Jyrki P., University of Helsinki, BioMag Laboratory, University of Helsinki, Lastenneurologian yksikkö, Hernandez-Pavon, Julio C., Makela, Niko, Lehtinen, Henri, Lioumis, Pantelis, and Makela, Jyrki P.
- Published
- 2014
158. Direct Cortical Motor Evoked Potentials Versus Transcranial Motor Evoked Potentials for the Detection of Cortical Ischemia During Supratentorial Craniotomy: Case Report.
- Author
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Silverstein JW, Rosenthal A, and Ellis JA
- Abstract
Transcranial motor evoked potential (TCMEP) and direct cortical motor evoked potential (DCMEP) paradigms have historically been used contemporaneously or independently for supratentorial craniotomies. DCMEP provides focal stimulation to the cortical surface, whereas TCMEP stimulation is more variable and may be activating structures deeper than those at risk during a supratentorial craniotomy. We present the case report for a 65-year-old female who underwent a supratentorial craniotomy for the clipping of a right-sided unruptured middle cerebral artery (MCA) aneurysm. DCMEP recordings of the upper extremity degraded after the parent vessel was temporarily occluded with a clip. The recordings returned once the clip was released. The DCMEP lower extremity recordings did not deviate from their established baseline. TCMEP recordings (upper and lower extremities) also did not deviate from their established baselines. The permanent clip was placed without incident, and the patient awoke neurologically intact. This case study demonstrates the specificity and sensitivity of DCMEP vs. TCMEP. DCMEP activates the corticospinal tract more superficially; therefore, it was evident by the loss of the upper extremity DCMEPs without the loss of lower extremity DCMEPs that the temporary vessel occlusion caused an ischemic event focal to the cortical area perfused by the MCA. This ischemic event was not detected by TCMEP., Competing Interests: The authors have declared that no competing interests exist.
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- 2018
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159. Experimental Study of the Course of Threshold Current, Voltage and Electrode Impedance During Stepwise Stimulation From the Skin Surface to the Human Cortex
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Simon Herrlich, Joris van den Berg, Andrea Szelényi, J. Marc C. van Dijk, Gianni M. Galistu, and Henricus Louis Journée
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Adult ,Male ,Materials science ,medicine.medical_treatment ,Biophysics ,Stimulation ,Direct cortical stimulation ,lcsh:RC321-571 ,CEREBRAL ANEURYSM SURGERY ,Monitoring, Intraoperative ,LIVE HUMAN SKULL ,Electric Impedance ,medicine ,Transcranial stimulation ,Humans ,Motor evoked potential ,Current stimulation ,Electrical impedance ,Neurostimulation ,lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry ,Aged ,Skin ,Scalp ,Voltage stimulation ,General Neuroscience ,Skull ,Motor Cortex ,Impedance ,Brain ,PAIN ,Anatomy ,CONDUCTIVITIES ,Middle Aged ,ANESTHETIZED HUMANS ,Evoked Potentials, Motor ,Electric Stimulation ,medicine.anatomical_structure ,MOTOR EVOKED-POTENTIALS ,Cerebral cortex ,Electrode ,TRANSCRANIAL ELECTRICAL-STIMULATION ,Constant current ,Female ,Neurology (clinical) ,Craniotomy ,Biomedical engineering ,Voltage - Abstract
Background: Transcranial electric stimulation as used during intraoperative neurostimulation is dependent on electrode and skull impedances.Objective: Threshold currents, voltages and electrode impedances were evaluated with electrical stimulation at 8 successive layers between the skin and the cerebral cortex.Patients and Methods: Data of 10 patients (6f, 53 +/- 11 years) were analyzed. Motor evoked potentials were elicited by constant current stimulation with corkscrew type electrodes (CS) at C3 and C4 in line with standard transcranial electric stimulation. A monopolar anodal ball tip shaped probe was used for all other measurements being performed at the level of the skin, dura and cortex, as well as within the skull by stepwise performed burr holes close to C3 resp. C4.Results: Average stimulation intensity, corresponding voltage and impedance for muscle MEPs at current motor threshold (CMT) were recorded: CS 54 +/- 23 mA (mean +/- SD), 38 +/- 21 V. 686 +/- 146 Omega; with the monopolar probe on skin 55 +/- 28 mA, 100 +/- 44 V. 1911 +/- 683 Omega and scalp 59 +/- 32 mA, 56 +/- 28 V. 1010 +/- 402 Omega; within the skull bone: outer compact layer 33 23 mA, 91 +/- 53 V. 3734 +/- 2793 Omega; spongiform layer 33 +/- 23 mA, 70 +/- 44 V.2347 +/- 1327 Omega; inner compact layer (ICL) 28 +/- 19 mA, 48 +/- 23 V. 2103 +/- 14980; on dura 25 +/- 12 mA, 17 +/- 12 V.643 +/- 244 Omega and cortex 14 +/- 6 mA, 11 +/- 5 V.859 +/- 300 Omega. CMTs were only significantly different for CS (P = 0.02) and for the monopolar probe between the cortex and ICL (P = 0.03), scalp (P = 0.01) or skin (P = 0.01) and between ICL and CS (PConclusion: The mean stimulation current of the CMT along the extracranial to intracranial anodal trajectory followed a stepwise reduction. VMT was strongly dependent on electrode impedance. CMT within the skull layers was noted to have relative strong shunting currents in scalp layers. (C) 2013 Elsevier Inc. All rights reserved.
- Published
- 2013
160. Navigated Brain Stimulation (NBS) for Pre-Surgical Planning of Brain Lesion in Critical Areas: Basic Principles and Early Experience
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Alafaci C, Conti A, Tomasello F., Dr. Terry Lichtor, Alafaci C, Conti A, and Tomasello F.
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brain Mapping ,direct cortical stimulation ,navigated trans cranial stimulation - Abstract
Modern neurosurgery attempts to get the difficult goal of combining an "aggressive" resection of brain tumors with the fundamental purpose of preserving brain functions and best possible quality of life. One of the most important evolutions of neurosurgical therapies is the opportunity to provide a customized surgical intervention by using modern methods to "map" the eloquent areas of the brain. This allows the identification of brain functional areas to be preserved from possible inadvertent intraoperative damage. Direct cortical stimulation (DCS) is an intraoperative technique that uses electrodes placed directly on the exposed cortical surface of the brain to stimulate activity of functional areas by simultaneously recording the evoked responses peripherally. DCS is very precise and reliable and can be considered the gold standard in brain mapping and intraoperative functional monitoring. Nevertheless, the neurosurgeon discovers the spatial relationship between the disease and eloquent cortical surfaces only after having completed a craniotomy and dural opening. A pre-surgical mapping method would give the opportunity to plan the treatment of brain diseases optimizing many aspects of the surgical treatment, including patient positioning, type of anesthesia, size of craniotomy, and extent of resection. Moreover, pre-surgical mapping would allow more precise prediction of the efficacy and risks of treatments that can be discussed with the patient and influence the therapeutic strategy. New techniques have been proposed in an attempt to provide a reliable method for the functional study that can be, however, exploited pre-operatively. The most recent of these methods of mapping cortical activities is navigated brain stimulation (NBS), which is based on the neurophysiological technique of transcranial magnetic stimulation (TMS) of the cerebral cortex combined with the conventional neuronavigation. Basic principles of NBS will be here discussed together with our preliminary experience using this technique in different neurosurgical diseases.
- Published
- 2013
161. Preoperative multimodal motor mapping: a comparison of magnetoencephalography imaging, navigated transcranial magnetic stimulation, and direct cortical stimulation
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Danielle Mizuiri, Mitchel S. Berger, Matthew C. Tate, Srikantan S. Nagarajan, Anne M. Findlay, Susanne M. Honma, and Phiroz E. Tarapore
- Subjects
magnetoencephalography ,Male ,genetic structures ,medicine.medical_treatment ,direct cortical stimulation ,Brain mapping ,Computer-Assisted ,Postoperative Complications ,transcranial magnetic stimulation ,Prospective Studies ,Cortical Synchronization ,Motor skill ,Craniotomy ,Cerebral Cortex ,Brain Mapping ,medicine.diagnostic_test ,Brain Neoplasms ,Motor Cortex ,Magnetoencephalography ,Signal Processing, Computer-Assisted ,General Medicine ,Middle Aged ,Transcranial Magnetic Stimulation ,Paresis ,medicine.anatomical_structure ,Motor Skills ,Biomedical Imaging ,Female ,Primary motor cortex ,psychological phenomena and processes ,Motor cortex ,Adult ,Cerebral ,Clinical Sciences ,Bioengineering ,behavioral disciplines and activities ,Article ,Young Adult ,Clinical Research ,Preoperative Care ,medicine ,Humans ,Dominance, Cerebral ,Dominance ,Aged ,Neurology & Neurosurgery ,business.industry ,Neurosciences ,motor mapping ,Somatosensory Cortex ,Electric Stimulation ,Transcranial magnetic stimulation ,nervous system ,Signal Processing ,Nuclear medicine ,business ,Neuroscience ,Software - Abstract
Object Direct cortical stimulation (DCS) is the gold-standard technique for motor mapping during craniotomy. However, preoperative noninvasive motor mapping is becoming increasingly accurate. Two such noninvasive modalities are navigated transcranial magnetic stimulation (TMS) and magnetoencephalography (MEG) imaging. While MEG imaging has already been extensively validated as an accurate modality of noninvasive motor mapping, TMS is less well studied. In this study, the authors compared the accuracy of TMS to both DCS and MEG imaging. Methods Patients with tumors in proximity to primary motor cortex underwent preoperative TMS and MEG imaging for motor mapping. The patients subsequently underwent motor mapping via intraoperative DCS. The loci of maximal response were recorded from each modality and compared. Motor strength was assessed at 3 months postoperatively. Results Transcranial magnetic stimulation and MEG imaging were performed on 24 patients. Intraoperative DCS yielded 8 positive motor sites in 5 patients. The median distance ± SEM between TMS and DCS motor sites was 2.13 ± 0.29 mm, and between TMS and MEG imaging motor sites was 4.71 ± 1.08 mm. In no patients did DCS motor mapping reveal a motor site that was unrecognized by TMS. Three of 24 patients developed new, early neurological deficit in the form of upper-extremity paresis. At the 3-month follow-up evaluation, 2 of these patients were significantly improved, experiencing difficulty only with fine motor tasks; the remaining patient had improvement to 4/5 strength. There were no deaths over the course of the study. Conclusions Maps of the motor system generated with TMS correlate well with those generated by both MEG imaging and DCS. Negative TMS mapping also correlates with negative DCS mapping. Navigated TMS is an accurate modality for noninvasively generating preoperative motor maps.
- Published
- 2012
162. Is preoperative functional magnetic resonance imaging reliable for language areas mapping in brain tumor surgery? Review of language functional magnetic resonance imaging and direct cortical stimulation correlation studies
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Costanza Papagno, David Pirillo, Carlo Giussani, Frank Emmanuel Roux, Erik P. Sganzerla, Jeffrey G. Ojemann, Giussani, C, Roux, F, Ojemann, J, Sganzerla, E, Pirillo, D, and Papagno, C
- Subjects
Pathology ,medicine.medical_specialty ,Statistics as Topic ,Functional magnetic resonance imaging ,Direct cortical stimulation ,Preoperative care ,Brain mapping ,Correlation ,Text mining ,medicine ,Image Processing, Computer-Assisted ,Humans ,Brain tumor surgery ,Language ,Cerebral Cortex ,Brain Mapping ,Modalities ,medicine.diagnostic_test ,business.industry ,Brain Neoplasms ,MED/27 - NEUROCHIRURGIA ,Magnetic Resonance Imaging ,Electric Stimulation ,Functional imaging ,Oxygen ,Surgery ,Neurology (clinical) ,business ,Neuroscience - Abstract
OBJECTIVE: Language functional magnetic resonance imaging (fMRI) has been used extensively in the past decade for both clinical and research purposes. Its integration in the preoperative imaging assessment of brain lesions involving eloquent areas is progressively more diffused in neurosurgical practice. Nevertheless, the reliability of language fMRI is unclear. To understand the reliability of preoperative language fMRI in patients operated on for brain tumors, the surgical studies that compared language fMRI with direct cortical stimulation (DCS) were reviewed. METHODS: Articles comparing language fMRI with DCS of language areas were reviewed with attention to the lesion pathology, the magnetic field, the language tasks used pre- and intraoperatively, and the validation modalities adopted to establish the reliability of language fMRI. We tried to explore the effectiveness of language fMRI in gliomas. RESULTS: Nine language brain mapping studies compared the findings of fMRI with those of DCS. The studies are not homogeneous for tumor types, magnetic fields, pre- and intraoperative language tasks, intraoperative matching criteria, and results. Sensitivity and specificity were calculated in 5 studies (respectively ranging from 59% to 100% and from 0% to 97%). CONCLUSION: The contradictory results of these studies do not allow consideration of language fMRI as an alternative tool to DCS in brain lesions located in language areas, especially in gliomas because of the pattern of growth of these tumors. However, language fMRI conducted with high magnet fields is a promising brain mapping tool that must be validated by DCS in methodological robust studies. Copyright © 2010 by the Congress of Neurological Surgeons
- Published
- 2010
163. Is preoperative functional magnetic resonance imaging reliable for language areas mapping in brain tumor surgery? Review of language functional magnetic resonance imaging and direct cortical stimulation correlation studies
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Giussani, C, Roux, F, Ojemann, J, Sganzerla, E, Pirillo, D, Papagno, C, GIUSSANI, CARLO GIORGIO, Roux, FE, Ojemann, JG, SGANZERLA, ERIK PIETRO, PAPAGNO, COSTANZA, Giussani, C, Roux, F, Ojemann, J, Sganzerla, E, Pirillo, D, Papagno, C, GIUSSANI, CARLO GIORGIO, Roux, FE, Ojemann, JG, SGANZERLA, ERIK PIETRO, and PAPAGNO, COSTANZA
- Abstract
OBJECTIVE: Language functional magnetic resonance imaging (fMRI) has been used extensively in the past decade for both clinical and research purposes. Its integration in the preoperative imaging assessment of brain lesions involving eloquent areas is progressively more diffused in neurosurgical practice. Nevertheless, the reliability of language fMRI is unclear. To understand the reliability of preoperative language fMRI in patients operated on for brain tumors, the surgical studies that compared language fMRI with direct cortical stimulation (DCS) were reviewed. METHODS: Articles comparing language fMRI with DCS of language areas were reviewed with attention to the lesion pathology, the magnetic field, the language tasks used pre- and intraoperatively, and the validation modalities adopted to establish the reliability of language fMRI. We tried to explore the effectiveness of language fMRI in gliomas. RESULTS: Nine language brain mapping studies compared the findings of fMRI with those of DCS. The studies are not homogeneous for tumor types, magnetic fields, pre- and intraoperative language tasks, intraoperative matching criteria, and results. Sensitivity and specificity were calculated in 5 studies (respectively ranging from 59% to 100% and from 0% to 97%). CONCLUSION: The contradictory results of these studies do not allow consideration of language fMRI as an alternative tool to DCS in brain lesions located in language areas, especially in gliomas because of the pattern of growth of these tumors. However, language fMRI conducted with high magnet fields is a promising brain mapping tool that must be validated by DCS in methodological robust studies. Copyright © 2010 by the Congress of Neurological Surgeons
- Published
- 2010
164. Intraoperative optical imaging of metabolic changes after direct cortical stimulation - a clinical tool for guidance during tumor resection?
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Oelschlägel M, Meyer T, Schackert G, Kirsch M, Sobottka SB, and Morgenstern U
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- Glioma, Humans, Brain surgery, Brain Neoplasms pathology, Electric Stimulation methods, Neurosurgical Procedures methods
- Abstract
Brain tumor resection is even today one of the most challenging disciplines in neurosurgery. The current state of the art for the identification of tumor tissue during the surgical procedure comprises a wide variety of different tools, each with its own limitations and drawbacks. In this paper, we present a novel approach, the use of optical imaging in connection with direct electrical cortical stimulation (DCS), for identification of impaired tumor tissue and functional intact normal brain tissue under intraoperative conditions. Measurements with an optical imaging setup were performed as a proof of concept on three patients who underwent tumor resection of superficial gliomas. Direct electrical stimulations were applied on tumor tissue and surrounding brain tissue in each patient and characteristic features from the observed changes in the optical properties were compared between the different groups. The results reveal that in all patients a differentiation between non-functional tumor tissue and functional intact brain tissue was possible, and the technique might be a useful clinical tool in the future.
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- 2018
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165. Limitation of Intraoperative Transcranial Electrical Stimulation-Motor Evoked Potential Monitoring During Brain Tumor Resection Adjacent to the Primary Motor Cortex.
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Do HJ, Seo HG, Oh BM, Park CK, Kim JW, Choi YD, and Lee SH
- Abstract
Transcranial electrical stimulation-motor evoked potential (TES-MEP) is a valuable intraoperative monitoring technique during brain tumor surgery. However, TES can stimulate deep subcortical areas located far from the motor cortex. There is a concern about false-negative results from the use of TES-MEP during resection of those tumors adjacent to the primary motor cortex. Our study reports three cases of TES-MEP monitoring with false-negative results due to deep axonal stimulation during brain tumor resection. Although no significant change in TES-MEP was observed during surgery, study subjects experienced muscle weakness after surgery. Deep axonal stimulation of TES could give false-negative results. Therefore, a combined method of TES-MEP and direct cortical stimulation-motor evoked potential (DCS-MEP) or direct subcortical stimulation should be considered to overcome the limitation of TES-MEP.
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- 2018
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166. Cortical neuromodulation for neuropathic pain and Parkinson disease: Where are we?
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Lavano A, Guzzi G, and Chirchiglia D
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- Humans, Neuralgia, Parkinson Disease, Transcranial Direct Current Stimulation
- Abstract
Cortex neuromodulation is promising approach for treatment of some neurological conditions, especially neuropathic pain and Parkinson's disease. Effects of non-invasive cortical stimulation are short lived; transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) may be useful to assess the suitability for invasive cortical stimulation. Direct cortical stimulation (DCS) is the method able to provide long-lasting effects in treatment of neuropathic pain and some symptoms of Parkinson's disease through the use of totally implantable systems that ensure a chronic stimulation., (Copyright © 2017. Published by Elsevier Urban & Partner Sp. z o.o.)
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- 2018
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167. Recent Trends in the Use of Electrical Neuromodulation in Parkinson's Disease.
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Brittain JS and Cagnan H
- Abstract
Purpose of Review: This review aims to survey recent trends in electrical forms of neuromodulation, with a specific application to Parkinson's disease (PD). Emerging trends are identified, highlighting synergies in state-of-the-art neuromodulation strategies, with directions for future improvements in stimulation efficacy suggested., Recent Findings: Deep brain stimulation remains the most common and effective form of electrical stimulation for the treatment of PD. Evidence suggests that transcranial direct current stimulation (tDCS) most likely impacts the motor symptoms of the disease, with the most prominent results relating to rehabilitation. However, utility is limited due to its weak effects and high variability, with medication state a key confound for efficacy level. Recent innovations in transcranial alternating current stimulation (tACS) offer new areas for investigation., Summary: Our understanding of the mechanistic foundations of electrical current stimulation is advancing and as it does so, trends emerge which steer future clinical trials towards greater efficacy., Competing Interests: Compliance with Ethical StandardsDr. Brittain has a patent GB1700767.5 (Method and System For Determining Tremor Status) pending to Oxford University Innovation Limited. Dr. Cagnan has nothing to disclose.This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 2018
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168. The Cost of Brain Surgery: Awake vs Asleep Craniotomy for Perirolandic Region Tumors.
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Eseonu CI, Rincon-Torroella J, ReFaey K, and Quiñones-Hinojosa A
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- Anesthesia, General, Humans, Retrospective Studies, Wakefulness, Brain surgery, Brain Neoplasms surgery, Craniotomy economics, Craniotomy methods, Glioma surgery, Neurosurgical Procedures economics, Neurosurgical Procedures methods
- Abstract
Background: Cost effectiveness has become an important factor in the health care system, requiring surgeons to improve efficacy of procedures while reducing costs. An awake craniotomy (AC) with direct cortical stimulation (DCS) presents one method to resect eloquent region tumors; however, some authors assert that this procedure is an expensive alternative to surgery under general anesthesia (GA) with neuromonitoring., Objective: To evaluate the cost effectiveness and clinical outcomes between AC and GA patients., Methods: Retrospective analysis of a cohort of 17 patients with perirolandic gliomas who underwent an AC with DCS were case-control matched with 23 patients with perirolandic gliomas who underwent surgery under GA with neuromonitoring (ie, motor-evoked potentials, somatosensory-evoked potentials, phase reversal). Inpatient costs, quality-adjusted life years (QALY), extent of resection, and neurological outcome were compared between the groups., Results: Total inpatient expense per patient was $34 804 in the AC group and $46 798 in the GA group ( P = .046). QALY score for the AC group was 0.97 and 0.47 for the GA group ( P = .041). The incremental cost per QALY for the AC group was $82 720 less than the GA group. Postoperative Karnofsky performance status was 91.8 in the AC group and 81.3 in the GA group (P = .047). Length of hospitalization was 4.12 days in the AC group and 7.61 days in the GA group ( P = .049)., Conclusion: The total inpatient costs for awake craniotomies were lower than surgery under GA. This study suggests better cost effectiveness and neurological outcome with awake craniotomies for perirolandic gliomas., (Copyright © 2017 by the Congress of Neurological Surgeons)
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- 2017
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169. Intraoperative electrical stimulation in awake craniotomy: methodological aspects of current practice
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Andrea, Szelényi, Lorenzo, Bello, Hugues, Duffau, Enrica, Fava, Guenther C, Feigl, Miroslav, Galanda, Georg, Neuloh, Francesco, Signorelli, Francesco, Sala, and G, Spena
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low-grade glioma surgery ,medicine.medical_specialty ,Attitude of Health Personnel ,medicine.medical_treatment ,awake craniotomy ,direct cortical stimulation ,brain mapping ,Neurosurgery ,Stimulation ,Efferent Pathways ,Brain mapping ,Neurosurgical Procedures ,Monitoring, Intraoperative ,Glioma ,Neural Pathways ,medicine ,Humans ,Wakefulness ,Craniotomy ,Language ,Cerebral Cortex ,Brain Mapping ,Intraoperative Care ,Brain Neoplasms ,business.industry ,Brain ,Cognition ,General Medicine ,medicine.disease ,Electric Stimulation ,Surgery ,Neurology (clinical) ,business ,Neuroscience ,Electrical brain stimulation - Abstract
There is increasing evidence that the extent of tumor removal in low-grade glioma surgery is related to patient survival time. Thus, the goal of resecting the largest amount of tumor possible without leading to permanent neurological sequelae is a challenge for the neurosurgeon. Electrical stimulation of the brain to detect cortical and axonal areas involved in motor, language, and cognitive function and located within the tumor or along its boundaries has become an essential tool in combination with awake craniotomy. Based on a literature review, discussions within the European Low-Grade Glioma Group, and illustrative clinical experience, the authors of this paper provide an overview for neurosurgeons, neurophysiologists, linguists, and anesthesiologists as well as those new to the field about the stimulation techniques currently being used for mapping sensorimotor, language, and cognitive function in awake surgery for low-grade glioma. The paper is intended to help the understanding of these techniques and facilitate a comparison of results between users.
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- 2010
170. The sensory-motor profile awake-A new tool for pre-, intra-, and postoperative assessment of sensory-motor function.
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Becker J, Jehna M, Steinmann E, Mehdorn HM, Synowitz M, and Hartwigsen G
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- Adult, Humans, Intraoperative Neurophysiological Monitoring methods, Wakefulness, Brain Neoplasms physiopathology, Brain Neoplasms surgery, Craniotomy methods, Neurophysiological Monitoring methods, Outcome and Process Assessment, Health Care methods, Perioperative Period
- Abstract
Objectives: Awake craniotomy is a well-established procedure in surgery of intracranial tumors in eloquent areas. However, sufficiently standardized instruments for the assessment of sensory-motor function before, during and after the operation are currently lacking, despite their importance for evaluation of operative outcome., Patients and Methods: To address this issue, we designed a standardized assessment tool (the "sensory-motor profile awake scale"; SMP-a). The final scale consists of three motor sections (face, arm and leg) assessing both gross and fine motor skills and one sensory section. It differentiates between six grades of impairment and its tasks are applicable for intraoperative continuous monitoring of sensory-motor functions and supporting processes. We analyzed the data of 17 patients with intracranial tumors eligible for awake craniotomy who were preoperatively assessed with the SMP-a. In addition, we present an exemplary case., Results: Our data support the assumption that the SMP-a is feasible in patients eligible for awake craniotomy, even in patients with symptoms of mild aphasia or more severe sensory-motor deficits caused by tumor recurrence. The exemplary case demonstrates the feasibility of repeated measures with the SMP-a in a tumor patient, including the adaption of tasks to the individual requirements of an intraoperative setting., Conclusion: This exploratory study suggests that the SMP-a might be a feasible rating scale in patients with intracranial tumors. The flexibility of the scale enables individual adaption, but preserves the standardized scoring system to allow comparison between assessment dates, patients and, hopefully in the future, institutions. However, future studies are mandatory to provide data on the instrument's diagnostic properties with respect to feasibility, objectivity, validity and reliability., (Copyright © 2016 Elsevier B.V. All rights reserved.)
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- 2016
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171. Functional preoperative and intraoperative mapping and monitoring: increasing safety and efficacy in glioma surgery.
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Ottenhausen M, Krieg SM, Meyer B, and Ringel F
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- Brain Neoplasms pathology, Glioma pathology, Humans, Magnetic Resonance Imaging methods, Brain Neoplasms surgery, Diffusion Tensor Imaging, Glioma surgery, Monitoring, Intraoperative methods, Neuronavigation methods
- Abstract
Greater extent of resection (EOR) of low-grade gliomas is associated with improved survival. Proximity to eloquent cortical regions often limits resectability and elevates the risk of surgery-related deficits. Therefore, functional localization of eloquent cortex or subcortical fiber tracts can enhance the EOR and functional outcome. Imaging techniques such as functional MRI and diffusion tensor imaging fiber tracking, and neurophysiological methods like navigated transcranial magnetic stimulation and magnetoencephalography, make it possible to identify eloquent areas prior to resective surgery and to tailor indication and surgical approach but also to assess the surgical risk. Intraoperative monitoring with direct cortical stimulation and subcortical stimulation enables surgeons to preserve essential functional tissue during surgery. Through tailored pre- and intraoperative mapping and monitoring the EOR can be maximized, with reduced rates of surgery-related deficits.
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- 2015
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172. Neurostimulation for traumatic brain injury.
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Shin SS, Dixon CE, Okonkwo DO, and Richardson RM
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- Animals, Brain Injuries psychology, Deep Brain Stimulation, Humans, Recovery of Function, Treatment Outcome, Brain Injuries therapy, Electric Stimulation Therapy methods
- Abstract
Traumatic brain injury (TBI) remains a significant public health problem and is a leading cause of death and disability in many countries. Durable treatments for neurological function deficits following TBI have been elusive, as there are currently no FDA-approved therapeutic modalities for mitigating the consequences of TBI. Neurostimulation strategies using various forms of electrical stimulation have recently been applied to treat functional deficits in animal models and clinical stroke trials. The results from these studies suggest that neurostimulation may augment improvements in both motor and cognitive deficits after brain injury. Several studies have taken this approach in animal models of TBI, showing both behavioral enhancement and biological evidence of recovery. There have been only a few studies using deep brain stimulation (DBS) in human TBI patients, and future studies are warranted to validate the feasibility of this technique in the clinical treatment of TBI. In this review, the authors summarize insights from studies employing neurostimulation techniques in the setting of brain injury. Moreover, they relate these findings to the future prospect of using DBS to ameliorate motor and cognitive deficits following TBI.
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- 2014
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173. Intérêt du monitoring électrophysiologique au cours d’une chirurgie éveillée en neurochirurgie
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Trebuchon, A., Guye, M., Tcherniack, V., Tramoni, E., Bruder, N., and Metellus, P.
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ELECTROENCEPHALOGRAPHY , *BRAIN mapping , *ELECTRIC stimulation , *BRAIN function localization , *NEUROSURGERY , *BRAIN tumor treatment , *BRAIN surgery - Abstract
Abstract: Brain tumor surgery is at risk when lesions are located in eloquent areas. The interindividual anatomo-functional variability of the central nervous system implies that brain surgery within eloquent regions may induce neurological sequelae. Brain mapping using intraoperative direct electrical stimulation in awake patients has been for long validated as the standard for functional brain mapping. Direct electrical stimulation inducing a local transient electrical and functional disorganization is considered positive if the task performed by the patient is disturbed. The brain area stimulated is then considered as essential for the function tested. However, the exactitude of the information provided by this technique is cautious because the actual impact of cortical direct electrical stimulation is not known. Indeed, the possibility of false negative (insufficient intensity of the stimulation due to the heterogeneity of excitability threshold of different cortical areas) or false positive (current spread, interregional signal propagation responsible for remote effects, which make difficult the interpretation of positive or negative behavioural effects) constitute a limitation of this technique. To improve the sensitivity and specificity of this technique, we used an electrocorticographic recording system allowing a real time visualization of the local. We provide here evidence that direct cortical stimulation combined with electrocorticographic recording could be useful to detect remote after discharge and to adjust stimulation parameters. In addition this technique offers new perspective to better assess connectivity of cerebral networks. [Copyright &y& Elsevier]
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- 2012
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